Abstract
Purpose
This study aimed to determine the health-related quality of life (HRQoL) in mothers of 5-year-old very low birth weight (VLBW) and normal birth weight (NBW) children, with a focus on the role of stress.
Methods
This cohort study is ancillary to the Newborn Lung Project. A telephone interview collected information on symptoms of stress and HRQoL from 297 mothers of VLBW children and 290 mothers of NBW children who were enrolled in the Newborn Lung Project Statewide Cohort Study. Staged multiple regression analyses were used to evaluate the relationship between caregiver status and maternal HRQoL and the role stress played in this relationship. Additional multiple regression analyses were also used to evaluate the correlates of poor maternal HRQoL among VLBW mothers.
Results
Mothers of VLBW children experienced worse physical and mental HRQoL than mothers of NBW children. Adjusted analyses showed that physical HRQoL was significantly different between these mothers (β: −1.87, P = 0.001); this relationship was attenuated by maternal stress. Among the mothers of VLBW children, stress significantly contributed to adverse HRQoL outcomes when children were aged five. Child behavior problems at the age of two were also associated with worse subsequent maternal mental HRQoL (β: −0.18, P = 0.004), while each week of neonatal intensive care unit stay was associated with worse physical HRQoL (β: −0.26, P = 0.02).
Conclusions
Caring for a VLBW child is negatively associated with the HRQoL of mothers; this relationship might be, in part, explained by maternal stress. Addressing maternal stress may be an important way to improve long-term HRQoL.
Similar content being viewed by others
Abbreviations
- HRQoL:
-
Health-related quality of life
- VLBW:
-
Very low birth weight (<1,500 g)
- LBW:
-
Low birth weight (<2,500 g)
- NBW:
-
Normal birth weight
- NBL:
-
Newborn Lung Statewide Cohort Study
- SD:
-
Standard deviation
- ES:
-
Effect size
- NICU:
-
Neonatal intensive care unit
References
Singer, L. T., Fulton, S., Kirchner, H. L., Eisengart, S., Lewis, B., Short, E., et al. (2007). Parenting very low birth weight children at school age: Maternal stress and coping. Journal of Pediatrics, 151(5), 463–469.
Taylor, H. G., Klein, N., Minich, N. M., & Hack, M. (2001). Long-term family outcomes for children with very low birth weights. Archives of Pediatrics and Adolescent Medicine, 155(2), 155–161.
Dudek-Shriber, L. (2004). Parent stress in the neonatal intensive care unit and the influence of parent and infant characteristics. The American Journal of Occupational Therapy, 58(5), 509–520.
Singer, L. T., Salvator, A., Guo, S., Collin, M., Lilien, L., & Baley, J. (1999). Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. Journal of the American Medical Association, 281(9), 799–805.
Cronin, C. M., Shapiro, C. R., Casiro, O. G., & Cheang, M. S. (1995). The impact of very low-birth-weight infants on the family is long lasting. A matched control study. Archives of Pediatrics and Adolescent Medicine, 149(2), 151–158.
Eiser, C., Eiser, J. R., Mayhew, A. G., & Gibson, A. T. (2005). Parenting the premature infant: Balancing vulnerability and quality of life. Journal of Child Psychology and Psychiatry, 46(11), 1169–1177.
Donohue, P. K., Maurin, E., Kimzey, L., Allen, M. C., & Strobino, D. (2008). Quality of life of caregivers of very low-birth weight infants. Birth, 35(3), 212–219.
Halfon, N., & Hochstein, M. (2002). Life course health development: An integrated framework for developing health, policy, and research. The Milbank Quarterly, 80(3), 433–479. (iii).
Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.
Sameroff, A. (1975). Transactional models in early social relations. Human Development, 18(1–2), 65–79.
Biddle, B. (1979). Role theory: Expectations, identities and behaviours. New York: Academic Press.
House, J. S. (1974). Occupational stress and coronary heart disease: A review and theoretical integration. Journal of Health and Social Behavior, 15(1), 12–27.
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136.
Palta, M., & Sadek-Badawi, M. (2008). PedsQL relates to function and behavior in very low and normal birth weight 2- and 3-year-olds from a regional cohort. Quality of Life Research, 17(5), 691–700.
Ware, J., Jr., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.
Haley, S. M. (1992). Pediatric evaluation of disability inventory (PEDI): Development, standardization and administration manual. New England Medical Center Hospital, Dept. of Rehabilitation Medicine, PEDI Research Group.
Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQL (TM) 4.0: Reliability and validity of the A longer stay in the NICU was associated wi (TM) version 4.0 generic core scales in healthy and patient populations. Medical Care, 39(8), 800.
Achenbach, T. M., & Rescorla, L. A. (2000). Manual for the Achenbach system empirically based assessment (ASEBA), preschool forms and profiles. Burlington, VT: University of Vermont, Department of Psychiatry.
Carlson, L. E., & Thomas, B. C. (2007). Development of the Calgary Symptoms of Stress Inventory (c-sosi). International Journal of Behavioral Medicine, 14(4), 249–256.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). London: Lawrence Erlbaum.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.
Klassen, A. F., Lee, S. K., Raina, P., & Lisonkova, S. (2004). Psychological health of family caregivers of children admitted at birth to a NICU and healthy children: A population-based cross-sectional survey. BMC Pediatrics, 4(1), 24.
Tommiska, V., Ostberg, M., & Fellman, V. (2002). Parental stress in families of 2 year old extremely low birthweight infants. Archives of Disease in Childhood. Fetal and Neonatal Edition, 86(3), F161–F164.
Lee, C. F., Hwang, F. M., Chen, C. J., & Chien, L. Y. (2009). The interrelationships among parenting stress and quality of life of the caregiver and preschool child with very low birth weight. Family and Community Health, 32(3), 228–237.
Olshtain-Mann, O., & Auslander, G. K. (2008). Parents of preterm infants two months after discharge from the hospital: Are they still at (parental) risk? Health and Social Work, 33(4), 299–308.
Witt, W. P., Litzelman, K., Wisk, L. E., Spear, H. A., Catrine, K., Levin, N., et al. (2010). Stress-mediated quality of life outcomes in parents of childhood cancer and brain tumor survivors: A case-control study. Quality of Life Research, 19(7), 995–1005.
Schothorst, P. F., & van Engeland, H. (1996). Long-term behavioral sequelae of prematurity. Journal of the American Academy of Child and Adolescent Psychiatry, 35(2), 175–183.
Astbury, J., Orgill, A., & Bajuk, B. (1987). Relationship between two-year behaviour and neurodevelopmental outcome at five years of very low-birthweight survivors. Developmental Medicine and Child Neurology, 29(3), 370–379.
Williams, D. (2003). Pregnancy: A stress test for life. Current Opinion in Obstetrics and Gynecology, 15(6), 465–471.
Lykke, J. A., Langhoff-Roos, J., Sibai, B. M., Funai, E. F., Triche, E. W., & Paidas, M. J. (2009). Hypertensive pregnancy disorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension, 53(6), 944–951.
Trombini, E., Surcinelli, P., Piccioni, A., Alessandroni, R., & Faldella, G. (2008). Environmental factors associated with stress in mothers of preterm newborns. Acta Paediatric, 97(7), 894–898.
Obeidat, H. M., Bond, E. A., & Callister, L. C. (2009). The parental experience of having an infant in the newborn intensive care unit. The Journal of Perinatal Education, 18(3), 23–29.
Ye, G., Jiang, Z., Lu, S., & Le, Y. (2011). Premature infants born after preterm premature rupture of membranes with 24-34 weeks of gestation: A study of factors influencing length of neonatal intensive care unit stay. The Journal of Maternal-Fetal Medicine, 24(7), 960–965.
Aagaard, H., & Hall, E. O. (2008). Mothers’ experiences of having a preterm infant in the neonatal care unit: A meta-synthesis. Journal of Pediatric Nursing, 23(3), e26–e36.
Lindberg, B., & Ohrling, K. (2008). Experiences of having a prematurely born infant from the perspective of mothers in northern Sweden. International Journal of Circumpolar Health, 67(5), 461–471.
Wigert, H., Johansson, R., Berg, M., & Hellstrom, A. L. (2006). Mothers’ experiences of having their newborn child in a neonatal intensive care unit. Scandinavian Journal of Caring Sciences, 20(1), 35–41.
Esterling, B. A., Kiecolt-Glaser, J. K., & Glaser, R. (1996). Psychosocial modulation of cytokine-induced natural killer cell activity in older adults. The Psychosomatic Medicine, 58(3), 264–272.
Acknowledgments
This research was supported by grants from the National Institute of Child Health and Human Development (P30HD03352, Principal Investigator Marsha Mailick Seltzer and HD049533, Principal Investigator Whitney P. Witt). Birth-related and age two data collections were supported by a grant from the National Heart Lung and Blood Institute (R01 HL38149, Principal Investigator Mari Palta). Lauren E. Wisk was supported by a grant from the Graduate School of the University of Wisconsin, Madison (Principal Investigator: Witt) and a predoctoral NRSA Training Grant (T32 HS00083; Principal Investigator: Maureen Smith). Beth M. McManus acknowledges funding from the Robert Wood Johnson Health and Society Scholars Program at University of Wisconsin-Madison (53574; Principal Investigator: John Mullahy). Thank you to all of the parents who participated in this study. Thanks also to Mona Sadek Badawi and Aggie Albanese for their overall assistance in data acquisition and management. Thank you to Kathleen Madden for her help with telephone interviews, and to Ian Bakk for his assistance with data entry. We also wish to thank the anonymous reviewers for their valuable comments and input.
Conflict of interest
None of the authors has declared a conflict of interest with this research.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Witt, W.P., Litzelman, K., Spear, H.A. et al. Health-related quality of life of mothers of very low birth weight children at the age of five: results from the newborn lung project statewide cohort study. Qual Life Res 21, 1565–1576 (2012). https://doi.org/10.1007/s11136-011-0069-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-011-0069-3